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010-158-00-1000-LUP-1991-103
u Application for Land Use Fertn.it County o[ Sawyer H d _ 1'lie undecsigned hereby makes applicatiou for a Land Use Pecmit and ayrees � e that all work shall be done in accordance witlt the requirements of L'he Sawyer ° ■ County Zoning Ordinance and the laws and regulatione oE the State oE Wi�crn�sin. � ������ t' P12IN'f - USB ON1,Y ULACK 1NY./PlitlCIL K. � ��s��4 �ll��Q'.� �� S Q r"h e_ ner Builder � ���x S3�'�� S � m � malliug address mailing address F-,I A�Id[cEreL 1�.�� �`7�y3 -- — �G rn" -- cil:y, state, zi city, state, zip �uilding Land Use Zone District �L�--� (m New ( ) Filling � � ( ) Addition ( ) Dredging Lot size 3 3��,y Q '.( j�L, :3�" S � � � ( ) niteration ( ) Grading �^ n ( 1 Moving on O ncres � 76 c ) c ) a� New Construction ' � / Size �_ fC wide ft wide i � ft long ft long � Floor area � sq ft sq ft n�{� � tn tnl r� Total hgt � to peak � to peak �' Stories � � U� G Na� ' P7o. of bedrooms —' rear lot line or waterline (year round) or (seasonal) - , � � � h � 1 1 I � 7ype of bldg or addition � � ° 1 I N � ( ) Dwelling � i i (X) Garage (1) (� car i i �s O Storagc building � ��j' � C rt ( ) �oathouse � � i � ( ) Livingroom i 5 I1 � �I ( ) Bedroom � � � � i i ( ) Kitchen-dining i �,_ i ( ) Porch - enclosed/roofed j ;,,� � i ( ) Deck - open , j US �Z�-- ti�i� � c � G � ��5 a, �° l ' I ( ) � � V� �� ». � � '°' J J i Type of construction j - i (Y� Frame ( ) Block � � I i � y ( ) Log ( ) Concrete � � ' i ( ) Pole ( ) Steel j � � � °' a ( ) Metal ( ) � [t ,�� � O i � i � � �� i m Construction cost $ �80.�n � i � ° _,;.y � G i ` � � � �. , �va��� � �so� � � Vol �.- Pg I'7(c of deed! j - � � � ���1V,slGf . i } 2b i �'' � � � cstf vol �-- pg ^ i 2B G"�rQ �3�0' � ro � � N _..y�:_ Cer. Soil Test — i 3�3, � n � � IS�' � � � � -�7�/ ---.._ i�.(,r-`------CL�road�-------------- o ^ � Sanitary Pezmit / T'��� ( ( ��� UFr �j�LV�l�t �P1UE I � _ _ � �� Issued �� JUl�I�. I9q � Denied � o O � ,��� �.� - � � �� �-t��-��_ owner. Zoning Admin stra or . �` � , . � ' . 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'�w 4Q , . � � � , . - 1r g � � / . , ,i�; � -�- Q �.__ O y � � � : 7� ` : . � �' . ' .. r � r + • �'. .d ."�� . r L1�.C� �� [�1 � � `''�' —�t ! i I � .�"':► Plb u7 f,'-�� ��`'� y" %. r�• -,-� � "� `�f i� State of Wisconsin and County �'�"�'� ' Uniform Permit Application ,�„1. ''~,`-;.:'.�.,�w .. .-- for Private Domestic Sewage Systems State Permit . County Permit Number � Number � —ZS� A. LOCATION OF PREMISE WHERE SYSTEM WILI. BE CONSTRUCTED,ALTERED OR EXTENDED LEGAL DESCRIPTION: �-L-� , Name One: (Sec., Lot, Block) � CITY VILLAGE ,�I�%� C�_/'�=/c� _ ' ��-�f� (CI; c_" OWNSHIP _ ' B. GVJNER OF PROPERTY ' • �_ -•, - MAILING ADDRESS ��= ��/s�tS �lE���-/ - N me . � (Street,City, Zip�ode) ,�_ � , �-� � ..' �.� ' � ,L. /', � ��f�; y� , C. SEPTIC 7 NK CAPACITY �Gallons NEW INSTALLATION _,�1.�__ REPLACEMENT ADDITION MATERIALS: Prefab Concrete Poured in Place Steel�Other ; No.of Tanks ��� D. TYPE OF OCCUPANCY z �I�� One or Two Family Residence No.�_��o� — Commercial Industrial Other ' �������s� date �� = — �� (specify) �n���+��� ,� �� �_ ,��.�, �,�; E. APPLIANCES, ETC.: Food Waste Gr�inder YES �NO Automatic Clothes Washer YES � NO Dishwasher YES �NO Other (Specify) �7QZ'C-� F. EFFLUENT DISPOSAL SYSTEM NEW� EXTEFVSION ADDITION REPLACEMENT ' Seepage Trenches: No. Lin. Feet ' Trench Width _�,,£�Depth � Number of Lines �- Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pit: Inside diameter Liquid Depth � G. Percent of slope of land � % 2� � direction � H H. Indicate Slope of Land & direction of slope�on sketch I. Tile Depth PERCOLATION TE'ST , Indicate Soil map number And Soil Type , � ��� � Hours Water Test Time Drop in Water Level Inches Minutes Test Depth Character of Soil Since Hole in Hole Interval Second to Next to Last To Fall Number Inches Thickness in Inches � st Wetted Overnight in Minutes Last Period Last Period Period One Inch � l�" '�'�.cf —:�r•'�Y � � ��'. �;, ;z /l�c, � �r�" ,, ~� 4 '� ;�� ./� ? �} � .�" � , -�,� `r `.- l c��/ � � � ' t /I�r' � � � . :/� (;� <, '� � � , �:� ? 1/ �1� i RECORD DATA FROM MINIMUM OF 3 TEST HOLES IN THE AREA IN WHICH THE S STEM IS TO BE INSTAL�ED , ; S 0 I L�E O R I N G S — (Vlinimum 36" Below Proposed Absorption System � �— � Boring Total Depth Depth to Ground Water Depth to Bedrock i �Number I Inches Observed Estimated Observed Estimated Character of Soil wi h Thic ness in Inches � a q / y � ' {� ,��' � � 0 z� D '"1 � / y '�� � . .y c. ry �.—• l� �',� �� �` G y �c)J �/ n /! � � . � y /' j �. �y � H . t r RECORD DATA FROM MINIMUM OF 3 BORE HOLES IN THE AREA IN WHICH THE SYSTEM IS TO BE INSTALLED (COMPLETE OTHER SIDE► . Name of O�vncr �ST�� �....�.`� LC��tc�A� County 5�����,_ Permit No.��'f� PERCO�ATION TESTS I, the undersigned, hereby certify that the Percolation Tests reported on this form were made by me or under my supervision in accord with the procedures and method specified in Section H 62.20 (3), Wisconsin Administrative Code, and ihat the data. recorded and location of test holes re correct to the best of my knowledge and b lief. NAME �' r' � ���1��,T '�ti'f�/ TITLE C���-n (Type or Print) - REGISTRATION N0. or MASTER PLUMBER LICENSE No.��S Z � a ADDRESS ���t.:..��� � / / ' ' � ' DATE OF TEST ��.�` � y SIGNATURE ' �` ' � � --------------------------- - - MASTER PLUMBER ,'KIN� APPLICATIO 'MP ��.--��L , Signature: ��. '� �'/� ' License Number: MP f�SW � � For: _�� � Provide sketch below of system (em loyer) (lnclude direction and percent of slope and ail applicabie distances) _ , - _ ___—___. � � ate _ __ i . ' . , ' ' j I � - � I i � � � � �-- -� � 20� � : � PLAN .VIEW (Loc Percolation "fes�& Soil,Bore Hpies) __�.__,- _ . ----- 15 ; /� '�' ' '�--e � f � � � � � i � _ __ , � I I ! + � I �"_ , I ! i _ I � i_ _ ' - --- __..------- ; - � . I t � , � '- j � I , Jy i i I / � I , , l� � 10' ! , "�t � � i i i ' � ' �%,�j - ' c'-c' .! > � _.. _----- ' • . - , � . �. � ' I 5 ; , , � _i—: ----� -.. I, I , ._-- -- i , , *� , ; , � I: i i --- --- --- -- -- , i i i �, , , a- � ����� �. , � _- -- ----- --- , ,�—:_ � __--- - _ ___ _ � �: � , � I � , , ' .I � , , , � / , � 5 ; •� ; ' ;___ �r�i� _ .__ _ - '- � -- - _ _.- ----, ---- -- . , , , � � � ; � ,� ! � /��'��—_ _� _ �o� � � i � - -- -- — - --— _ : . � , - -i-- � - : � � ; , '. �. ' ' ' ' � i � � � . . I ' 15, / - ,_ _ ; _ __ ___ ._ �__ _ _i_ __ _- 7/ y � , � r /� 20 / I DI ���;.'' �'��4� I_ �____ _ � _� _--- _- --- ' �i �- .� �.`�c ��, � / � i � , �,r- ,,!? � I � � � ( � � � � �5, ,�, � 5�, , ; � � � _f__ .. _ _ . - ---� - � -.. . _�t, � . , - ---� , 7 '1 i I �/�✓-�--.—r'-"'I I � . '. �_, ._�.�..._....__. _..__....._..__._...__.._.._..___._.._ .. .. �.._ � .�1.�... � i i I I ; _ PROF � (Indicate G 1 ' _. _' ' '' ' I LE � roundwater orlbed�rock_wFterelaPPlicable) _. .. ..--_.�—__ 4 _. . � I' , I I_ . . � i _ .! ' __.. � . __�_ �_ _I. _.. __. _...- - --___ _.. _ i_ _. __— --_- — ---_ . _ __ __. , � � l � � _. � � ._. I { � _i-- , � _. _ -� , � � �-- � � 2, � ' , ' _ � I . � , � _ � _ _ _ _ _ _--- - __ __. . I r. �� f � � � , . 4 ' - _ __ _ -- -- ' — - -- — -_ ; _. � ._ ,.._.- -- - � � _ ,. � , 3 ; � i � ; ; ; � . I � �, , . _ , . _ __ �__ ._ . _ :_ _:_ ._ __ ___ __;_..__1 _ I , . � � , i ; �� , I �_ 1 , _ i ._ . �' ; ���� . , � , � , 5,_ _� ___ ;--- �_ --� ' �+ -- � -- --- — — --- ; ; - : , ' i ' � � .�, � ' � ' ; , ._ , � � � . � _.l --- � _ _ _ . - - - 6, __..� ._ � � — , ri ( __ , � — . j � � I . � I '� �I � I - , _ , j, � � , � ,' � ; � � i ' I � , _..... j_._. ' , ' � � ,_ � � - _ _ _ _ - - --- _ _ i y_ � � , � � . � � � � _ _ . � , i ' � , __ , : t _- - _ . 8, _-� i � � I � i 1 , � i j �� f � _ -- � -- -— -_ - - - —— • � � � ! i � f ! f i I . _. __ _----_. . _- -- -- � -�- . ; _. 9, { �_ � _ � _ _ , � ; I I � � � I f �Z�-Pt �, 10' � � ' ' : . _. , -- - - - - �, ; - - — -- -- -- -.. - -- I _ � i _ , . . _ _ . . .. � i � , � � ; I ' ' ' I � � I ! I I � I i � i ' - - � -- ----�- -- . _. . 11, : ; . . �_- ._ , _._ _._ _ � .__. ��_ � _. _ _ ��, Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Do not write in space below— FOR DEPARTMENT USE ONLY Date of Application ���T Z� ��7� Fees Paid State � �•�� County �0•00 Permit Issued/Aejesiad (date) OC�T l8 I�`+�[4- Inspection Yes�� � �� '��"�`►� Issuing Agent Name ���3�N k�QNt���— ��PUZ� Valid No. Date Rec'd DIVISION OF HEAITH,P.O.BOX 309,MADISnN,W1.53701 —Revised 4-1-73 � e ^ . � , Pib. ,',•' 60 3��� PRQJEC7 DETAfL DATA SHEET � l \'AME OF BUS I NESS �.� �, ,�f' -..• ���_` L 0 C AT I 0 N �1 �• �.�� _____���1�.r,_�� > >-� ., s1-~�t—c,�- h i ghway • ��oa- towns p ' co ty LEGAL DESC rPT I ON %��. ' �� " �'� ��i��0 ��1�/___`� ,� OWNER/�-���, j � ,� �,� ; � Mai 1 ing address /r��lz����r- �L-%.l�l ,�� ZIP ARCHITECT OR ENGINEER Address ZIP PI.UMBER �^` ;1��� :f-�.�� ��' -, � Address __��� �� �,(/�1� � __ I��—_ i --- Z I P __��'!� 1 . Check appropriate building usage(s) and fill i�n_the{; info ation re uested opposite each usage 1 isted: �'��� �.��: ����,� ��� • :"'."''....",.�::,,'"-.. 'o.. ExisLing building' . S�; Pdew building ���d it on If addition to existing building attach detailed memo for each. ( ) Drive in restaurant . . . . . . . . . Car spaces ( ) Restaurant . . . . . . . . . . . . . . . . . . Seating capacity (10 sq. ft./person) ( ) Dining hall . . . . . . . . . . . . . Per meal served Toitet waste Yes No ( ) Motel ( ) Hotel � Cottages . . Number of units : 2 persons/unit 4 persons/unit TOTAL NUMBER OF UNITS � ( ) Churches . . . . . . . . . . . . . . . . . . . . Number of persons Kitchen Yes � P�o ( ) Bar or cocktail lounge . . . . . . Seating capacity (10 sq. ft./person) O Nursing or rest home . . . . . . . . Number of beds ( ) Mobile home park . , . . . . . . . . . . Number of units - dependent (camper trailer) - nondependent (mobile home) ( ) Retail store . . . . . . . . . . . . . . . . Number of employees Number of customers �10 sq. ft./person) ( ) Service station . . . . . . . . . . . . . Number of cars served (daily) ( ) School . . . . . . . . . . . . . . . . . . . . . . Number of c�assrooms Meals served Yes � No � Showers provided Yes No O Factory or office building . . Number of persons (total all shifts ( ) Apartments . . . . . . . . . . . . . . . . . . Number of bedrooms , � ) 0 t h e r . . . . . . . . . . . . . . . . . . . . . . S pec i fy ___L__'�_��_?�._.���.____ 2. Indicate whether or not the foltowing facilities are connected: Food waste grinder Yes _ No �� Dishwasher Yes No � Automatic clothes washer Yes No )(? Automatic potato peeler Yes Other . . . (Specify) �,��__7^ No � 3. Fil1 in the appropriate information for the following as indicated: Septic tank capacity planned .y ���� Percolation test results - ATTACH PERCOLATION TEST AND SOIL BORINGS REPORT SHEET COMPLETE OTHER SIDE , ., . � Seepage trench bottom area planned �_��wfdth l inear feet !�)� depth _�� `' Seepage bed area planned width linear feet depth Seepage pit planned outside diameter dep[h below intet depth 4. See approved plan for specifications and details, Signature of person completing form: STATE DIVISION OF HEALTH, P BIPIG SE�4,ION P. 0. B Madison, Wi co sin 53701 i�i.�'/;�i 1/�-LC.�7-:�>_.. � Approve ��`r',°' �� Address: /�� " Z S�/ /� , , Date:�c� 7 �p'�, . .i'.,r. :� 'T . � � �o�� l� � s ZIP ' THIS APPROVAL IS BASED ON STATE PLUMBING � CODE REQUIREMENTS AND DOES NOT EXEMPT THE Date: INSTALLATION FROM CITY, VILLAGE, TOWNSHIP L.� / OR COUNTY PERMIT REQUIREMENTS AND SHALL BE �""��`" //�`'/7� V01 D I F REV I SED WITHOUT THE WR ITTEN APPROYAL OF THE DIVISION OF HEALTH. DEPARTMENTAL USE ONLY THIS APPROVAL SHALL BE V01'v� NOT INSTALLED WITHIN TWO Y . � FROM THE DATE OF APPROVAL � I Department of Zoning and Sanitation Sawyer County Inspection Report 7�57� Name of property �EK��S P�saeT Description �(fE�_ ,��(j_ �,�c. 3G — Tyo� - : lJ O4mer Address Builder Address Master Plumber �, aA�czF�s,ri Address Inspection � Q� Private ( ) Public Property Sanitary Installation Dwelling Privy Violation Mobile home Setback - Lake Garage Setback - Road ( � Sanitary ( ) Zoning Setback - Lot line L,aKF __ \ I --------, �a h � � � �� C��,,� � '` e-�"`", ,� �°0 6 3s ' �� . Discussed Frith Builder � Yes {}� No Discussed with Plumber Yes � � No Date of Inspection / � - /8- 7�/ Signature of Officer �<-��`J}C-1�r.---�Q . �, , ����°.�� /-���1' �, /�- U�t�...�, . � d y� %--� ,� � ��-�- �-�-,� - ����1�,�. �, ��������e , �� ���j7� �� 4 �r r+,�� � ����� - t � "� � ' '�"�' `-1 , ..p, rp . �i » �.:Eir�liC � �bi;.�� �,��� ���z � r : i � ,,� � � / ��( SL ' ,\ ,e 3 �, � �" `'w �� � �° \ \J � _ �� _ --- ` ,�/ � J'�' �� � , - ' � - � � . - �� . ;�,- w i �, � -�� t„ (�vh.� L2 i r � �`� ;� , � ' �� � .-h,�,, � 9,y��"� � � � �S �vtr�v, ���-� �� . Y �,� �,,��, . � � ``--- ��-� yf'�'�' ,yt-�'-� �,�. � � .��� ��` _ ..��,� oz.�� /o '�d�. ����. � . �� �� /t��'u"�,.�.�.u.r.-� �, � ,�� /�� � �j/��- � � � J ��2C4LG�Oz, ��J d�6�-, L{o"`'nf� 02 er- . ��.c4��a / . � f { F � { � � � 4��..° t! � !r{ �l���`.�«`�°� �' i t 1 F, � . � "-fi M�r's1d�i4� �'-�� ��41. „ �f �< \�%�:4� � W v`J ',�,�`�. � —- 'p�, wi.w� � "��1� �_+�E�2 � -13� VAL SHALL BE VOID IF ; ,1,,��r !'ti1S, y� �. U3: dSU��lNa � �d�i��1/��� �{'}7���*;�'✓r��� RQM iHE DI.T�E Of APPROO�EAR L '�ttli�L t'!'ve,.l�r�.. ,,,rnCVhL DF 7Hf�; LYG':3SJtd GF,:'.F�i�}: � - This approvalis based on state ptumbing . code requirements and does not ezemp{ the instatlaticn from city,��lage,towe, chip or cpu oty,¢rmi(re�uir�menf S.